CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 12 6.250000 231.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 130 192.500000 7122.5000 37.0000
Subtotal (Total Children Is Unduplicated) 134 199.750000 7353.7500 36.8148
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.000000 194.0000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 20.8400 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 4.000000 35.0000 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 8.0600 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 7.000000 152.8800 21.8400
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 65.1400 65.1400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.000000 114.5000 22.9000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 25.5300 25.5300
BEHV-BEHV-BEHAVIORAL ASSESSMENT 5 5.000000 625.0000 125.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 3 10.000000 500.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 213 364.250000 18208.9400 49.9902
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.000000 111.0000 55.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.500000 562.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.000000 431.2500 71.8750
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 22 39.000000 2164.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 213 327.000500 24505.0000 74.9387
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 56 89.500200 6712.5000 74.9998
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 86 159.000200 11925.0000 74.9999
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 191 325.500000 18025.1200 55.3767
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 142 220.500000 16147.5200 73.2314
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 16 85.000000 4250.0000 50.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 9 9.000000 459.4500 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 119 122.000000 6098.7200 49.9895
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 15 15.000000 765.7500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 56 57.000000 2771.0700 48.6153
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 167 171.000000 8690.1700 50.8197
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 21 22.000000 1123.1000 51.0500
Subtotal (Total Children Is Unduplicated) 1196 2070.250900 125319.6400 60.5336
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 36 52.000000 23841.2400 458.4854
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 239.2000 239.2000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1001 1142.500000 57003.7500 49.8939
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 53 37.500000 937.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1915 3118.000000 155812.5000 49.9719
CONIP-CONIP-CONSULT, ITDS PHONE 154 260.750000 6518.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 91 95.500000 4775.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 41 40.500000 2025.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 6 7.000000 175.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 167 163.000000 8150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 13.000000 325.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 96 6025.750000 150643.7500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 5 95.000000 4750.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 18 76.750000 3837.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6179 46845.00000 2339591.7200 49.9433
INTR-T1013-INTERPRETER 156 969.250000 44653.8200 46.0705
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 11395 103267.0000 932812.3800 9.0330
OCCT-97530-OT SESSION BY LICENSED OT 849 4670.750000 330607.3700 70.7825
OCCT-97530HM-OT SESSION BY OT ASST 224 868.249999 49634.4200 57.1660
PHY-97110-PT SESSION BY LICENSED PT 909 5421.772500 375075.0200 69.1794
PHY-97110HM-PT SESSION BY PT ASST 151 705.250100 40258.5100 57.0840
SENS-V5140-BEHIND THE EAR BINAURAL HEARING AID
1 1.000000 474.2000 474.2000
SENS-V5264-EARMOLD 2 3.000000 54.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2305 15148.96060 1066546.1400 70.4039
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 92 221.000000 12641.2000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 26 70.250000 1021.1500 14.5359
TRAV-TRAVS-Travel by mile 4138 389171.0000 172392.7600 0.4430
Subtotal (Total Children Is Unduplicated) 12328 578491.7332 5784846.8800 9.9999
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Total 580761.734099 5917520.2700 10.1892
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Number of Children (Unduplicated) With at Least One Service 12520
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 6781 12380.000000 146615.4200 146615.4200
D 7 7.000000 500.0800 0.0000
S 20 20.000000 853.6200 240.0000
H 0 0.000000 0.0000 0.0000
T 2767 6809.250000 62263.6900 63268.4000
1113 4151.750000 23756.2000 287.0800
Other 4 4.000000 285.7600 0.0000
---------------------------------------------------------
Total 10692 23372.000000 234274.7700 210410.9000
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 1 1.000000 10.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3718 10882.250000 113063.7100 82808.5800
499 519.750000 19724.4800 121.4400
Other 7 15.250000 167.5100 40.0000
---------------------------------------------------------
Total 4225 11418.250000 132965.7000 82970.0200
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
9820 67615.500000 189129.2800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9820 67615.500000 189129.2800 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 16 16.750000 619.7500 0.0000
P 3491 11387.250000 199651.9900 199651.9900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2350 8160.000000 409433.6800 281.4400
T 0 0.000000 0.0000 0.0000
466 5893.500000 167523.3500 0.0000
Other 56 124.000000 7874.0900 1055.1400
---------------------------------------------------------
Total 6379 25581.500000 785102.8600 200988.5700
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 3564 56644.250000 145446.5100 145396.0150
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
17 74.250000 804.5800 451.3000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3581 56718.500000 146251.0900 145847.3150
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 6331 5986.000000 134000.6900 134000.6900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4071 13789.500000 93062.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10402 19775.500000 227063.2100 134000.6900
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 4296 12803.000000 207990.6700 207990.6700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
55 127.000000 6823.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4351 12930.000000 214814.4500 207990.6700
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 10767 146155.000000 662971.4300 662988.5100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2159 10556.500000 340192.6100 418.5700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12926 156711.500000 1003164.0400 663407.0800
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 7990 24218.750000 576890.2500 576850.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2955 9627.250000 507486.0700 511.8600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10945 33846.000000 1084376.3200 577362.1100
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 2080 6442.750000 209279.9800 209279.9800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
896 2524.500000 151786.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2976 8967.250000 361065.9800 209279.9800
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 2.000000 150.0000 0.0000
P 1 2.000000 59.5700 59.5700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2591 25042.750000 126134.4300 126140.4600
598 1451.500000 87435.4200 40.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3191 26498.250000 213779.4200 126240.0300
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1908 10236.950000 23928.3900 23928.3900
T 2115 13196.750000 23740.4900 23740.4900
1801 4481.300000 80785.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5824 27915.000000 128454.3100 47668.8800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4878 28706.390000 74133.4500 74133.4500
T 3071 17370.250000 43917.4500 43907.4500
6046 22721.630000 188195.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13995 68798.270000 306246.8900 118040.9000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 7781 10812.070940 185348.3000 185348.3000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3831 3314.643159 220125.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11612 14126.714099 405473.5600 185348.3000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 204 924.500000 8685.7800 8685.7800
H 0 0.000000 0.0000 0.0000
T 2896 19989.750000 195370.3700 205530.3700
1816 5513.000000 279481.3200 279281.3200
Other 35 60.250000 1820.9200 1820.9200
---------------------------------------------------------
Total 4951 26487.500000 485358.3900 495318.3900